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Dental Emergencies
Toothache: Clean the area of the
affected tooth. Rinse the mouth thoroughly with warm water or use
dental floss to dislodge any food that may be impacted. If the pain
still exists, contact your child's dentist. Do not place aspirin or
heat on the gum or on the aching tooth. If the face is swollen,
apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek:
Apply ice to injured areas to help control swelling. If there is
bleeding, apply firm but gentle pressure with a gauze or cloth. If
bleeding cannot be controlled by simple pressure, call a doctor or
visit the hospital emergency room.
Knocked Out Permanent Tooth:
If possible, find the tooth. Handle it by the crown, not by the
root. You may rinse the tooth with water only. DO NOT clean with
soap, scrub or handle the tooth unnecessarily. Inspect the tooth for
fractures. If it is sound, try to reinsert it in the socket. Have
the patient hold the tooth in place by biting on a gauze. If you
cannot reinsert the tooth, transport the tooth in a cup containing
the patient’s saliva or milk. If the patient is old enough, the
tooth may also be carried in the patient’s mouth (beside the cheek).
The patient must see a dentist IMMEDIATELY! Time is a critical
factor in saving the tooth.
Knocked Out Baby Tooth: Contact your
pediatric dentist during business hours. This is not usually an
emergency, and in most cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth:
Contact your pediatric dentist immediately. Quick action can save
the tooth, prevent infection and reduce the need for extensive
dental treatment. Rinse the mouth with water and apply cold
compresses to reduce swelling. If possible, locate and save any
broken tooth fragments and bring them with you to the dentist.
Chipped or Fractured Baby Tooth: Contact
your pediatric dentist.
Severe Blow to the Head: Take your child
to the nearest hospital emergency room immediately.
Possible Broken or Fractured Jaw:
Keep the jaw from moving and take your child to the nearest hospital
emergency room.
Dental Radiographs
(X-Rays)
Radiographs
(X-Rays) are a vital and necessary part of your child’s dental
diagnostic process. Without them, certain dental conditions can and
will be missed.
Radiographs
detect much more than cavities. For example, radiographs may be
needed to survey erupting teeth, diagnose bone diseases, evaluate
the results of an injury, or plan orthodontic treatment. Radiographs
allow dentists to diagnose and treat health conditions that cannot
be detected during a clinical examination. If dental problems are
found and treated early, dental care is more comfortable for your
child and more affordable for you.
The American
Academy of Pediatric Dentistry recommends radiographs and
examinations every six months for children with a high risk of tooth
decay. On average, most pediatric dentists request radiographs
approximately once a year. Approximately every 3 years, it is a good
idea to obtain a complete set of radiographs, either a panoramic and
bitewings or periapicals and bitewings.
Pediatric
dentists are particularly careful to minimize the exposure of their
patients to radiation. With contemporary safeguards, the amount of
radiation received in a dental X-ray examination is extremely small.
The risk is negligible. In fact, the dental radiographs represent a
far smaller risk than an undetected and untreated dental problem.
Lead body aprons and shields will protect your child. Today’s
equipment filters out unnecessary x-rays and restricts the x-ray
beam to the area of interest. High-speed film and proper shielding
assure that your child receives a minimal amount of radiation
exposure.
What’s the Best
Toothpaste for my Child?
Tooth
brushing is one of the most important tasks for good oral health.
Many toothpastes, and/or tooth polishes, however, can damage young
smiles. They contain harsh abrasives, which can wear away young
tooth enamel. When looking for a toothpaste for your child, make
sure to pick one that is recommended by the American Dental
Association as shown on the box and tube. These toothpastes have
undergone testing to insure they are safe to use.
Remember,
children should spit out toothpaste after brushing to avoid getting
too much fluoride. If too much fluoride is ingested, a condition
known as fluorosis can occur. If your child is too young or unable
to spit out toothpaste, consider providing them with a fluoride free
toothpaste, using no toothpaste, or using only a "pea size" amount
of toothpaste.
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Does Your Child Grind
His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal
grinding of teeth (bruxism). Often, the first indication is the
noise created by the child grinding on their teeth during sleep. Or,
the parent may notice wear (teeth getting shorter) to the dentition.
One theory as to the cause involves a psychological component.
Stress due to a new environment, divorce, changes at school; etc.
can influence a child to grind their teeth. Another theory relates
to pressure in the inner ear at night. If there are pressure changes
(like in an airplane during take-off and landing, when people are
chewing gum, etc. to equalize pressure) the child will grind by
moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not
require any treatment. If excessive wear of the teeth (attrition) is
present, then a mouth guard (night guard) may be indicated. The
negatives to a mouth guard are the possibility of choking if the
appliance becomes dislodged during sleep and it may interfere with
growth of the jaws. The positive is obvious by preventing wear to
the primary dentition.
The good news is most children outgrow bruxism.
The grinding decreases between the ages 6-9 and children tend to
stop grinding between ages 9-12. If you suspect bruxism, discuss
this with your pediatrician or pediatric dentist.
Thumb
Sucking
Sucking is a natural reflex and infants and young
children may use thumbs, fingers, pacifiers and other objects on
which to suck. It may make them feel secure and happy, or provide a
sense of security at difficult periods. Since thumb sucking is
relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption
of the permanent teeth can cause problems with the proper growth of
the mouth and tooth alignment. How intensely a child sucks on
fingers or thumbs will determine whether or not dental problems may
result. Children who rest their thumbs passively in their mouths are
less likely to have difficulty than those who vigorously suck their
thumbs.
Children should cease thumb sucking by the time
their permanent front teeth are ready to erupt. Usually, children
stop between the ages of two and four. Peer pressure causes many
school-aged children to stop.
Pacifiers are no substitute for thumb sucking.
They can affect the teeth essentially the same way as sucking
fingers and thumbs. However, use of the pacifier can be controlled
and modified more easily than the thumb or finger habit. If you have
concerns about thumb sucking or use of a pacifier, consult your
pediatric dentist.
A few suggestions to help your child get through
thumb sucking:
-
Instead of scolding children for thumb sucking,
praise them when they are not.
-
Children often suck their thumbs when feeling
insecure. Focus on correcting the cause of anxiety, instead of the
thumb sucking.
-
Children who are sucking for comfort will feel
less of a need when their parents provide comfort.
-
Reward children when they refrain from sucking
during difficult periods, such as when being separated from their
parents.
-
Your pediatric dentist can encourage children
to stop sucking and explain what could happen if they continue.
-
If these approaches don’t work, remind the
children of their habit by bandaging the thumb or putting a sock
on the hand at night. Your pediatric dentist may recommend the use
of a mouth appliance.
What is Pulp Therapy?
The pulp of a tooth is the inner,
central core of the tooth. The pulp contains nerves, blood vessels,
connective tissue and reparative cells. The purpose of pulp therapy
in Pediatric Dentistry is to maintain the vitality of the affected
tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic
injury are the main reasons for a tooth to require pulp therapy.
Pulp therapy is often referred to as a "nerve treatment",
"children's root canal", "pulpectomy" or "pulpotomy". The two
common forms of pulp therapy in children's teeth are the pulpotomy
and pulpectomy.
A pulpotomy removes the diseased pulp
tissue within the crown portion of the tooth. Next, an agent is
placed to prevent bacterial growth and to calm the remaining nerve
tissue. This is followed by a final restoration (usually a
stainless steel crown).
A pulpectomy is required when the entire
pulp is involved (into the root canal(s) of the tooth). During
this treatment, the diseased pulp tissue is completely removed from
both the crown and root. The canals are cleansed, disinfected and,
in the case of primary teeth, filled with a resorbable material.
Then, a final restoration is placed. A permanent tooth would be
filled with a non-resorbing material.
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What is
the Best Time for Orthodontic Treatment?
Developing malocclusions, or bad bites, can be
recognized as early as 2-3 years of age. Often, early steps can be
taken to reduce the need for major orthodontic treatment at a later
age.
Stage I – Early Treatment: This period of
treatment encompasses ages 2 to 6 years. At this young age, we are
concerned with underdeveloped dental arches, the premature loss of
primary teeth, and harmful habits such as finger or thumb sucking.
Treatment initiated in this stage of development is often very
successful and many times, though not always, can eliminate the need
for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period
covers the ages of 6 to 12 years, with the eruption of the permanent
incisor (front) teeth and 6 year molars. Treatment concerns deal
with jaw malrelationships and dental realignment problems. This is
an excellent stage to start treatment, when indicated, as your
child’s hard and soft tissues are usually very responsive to
orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This
stage deals with the permanent teeth and the development of the
final bite relationship.
EARLY INFANT
ORAL CARE
Your
Child’s First Dental Visit - Establishing a "Dental Home"
The American Academy of Pediatrics (AAP), the
American Dental Association (ADA), and the American Academy of
Pediatric Dentistry (AAPD) all recommend establishing a "Dental
Home" for your child by one year of age. Children who
have a dental home are more likely to receive appropriate preventive
and routine oral health care.
The Dental Home is
intended to provide a place other than the
Emergency Room for parents.
You can make the first visit to the dentist
enjoyable and positive. If old enough, your child should be informed
of the visit and told that the dentist and their staff will explain
all procedures and answer any questions. The less to-do concerning
the visit, the better.
It is best if you refrain from using words around
your child that might cause unnecessary fear, such as needle, pull,
drill or hurt. Pediatric dental offices make a practice of using
words that convey the same message, but are pleasant and
non-frightening to the child.
When Will My Baby Start
Getting Teeth?
Teething,
the process of baby (primary) teeth coming through the gums into the
mouth, is variable among individual babies. Some babies get their
teeth early and some get them late. In general, the first baby teeth
to appear are usually the lower front (anterior) teeth and they
usually begin erupting between the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for more details.
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Baby
Bottle Tooth Decay (Early Childhood Caries)
One serious form of decay among young children is
baby bottle tooth decay, also referred to by dentists as early
childhood caries. This condition is caused by frequent and long
exposures of an infant’s teeth to liquids that contain sugar. Among
these liquids are milk (including breast milk), formula, fruit juice
and other sweetened drinks.
Putting a baby to bed for a nap or at night with
a bottle other than water can cause serious and rapid tooth decay.
Sweet liquid pools around the child’s teeth giving plaque bacteria
an opportunity to produce acids that attack tooth enamel. If you
must give the baby a bottle as a comforter at bedtime, it should
contain only water. If your child won't fall asleep without the
bottle and its usual beverage, gradually dilute the bottle's
contents with water over a period of two to three weeks.
After each feeding, wipe the baby’s gums and
teeth with a damp washcloth or gauze pad to remove plaque. The
easiest way to do this is to sit down, place the child’s head in
your lap or lay the child on a dressing table or the floor. Whatever
position you use, be sure you can see into the child’s mouth easily.
PREVENTION
Care of Your Child’s
Teeth
Begin
daily brushing as soon as the child’s first tooth erupts. A
pea size amount of fluoride toothpaste can be used after the child
is old enough not to swallow it. By age 4 or 5, children should be
able to brush their own teeth twice a day with supervision until
about age seven to make sure they are doing a thorough job. However,
each child is different. Your dentist can help you determine whether
the child has the skill level to brush properly.
Proper brushing removes plaque from the inner,
outer and chewing surfaces. When teaching children to brush, place
toothbrush at a 45 degree angle; start along gum line with a soft
bristle brush in a gentle circular motion. Brush the outer surfaces
of each tooth, upper and lower. Repeat the same method on the inside
surfaces and chewing surfaces of all the teeth. Finish by brushing
the tongue to help freshen breath and remove bacteria.
Flossing removes plaque between the teeth, where
a toothbrush can’t reach. Flossing should begin when any two teeth
touch. You should floss the child’s teeth until he or she can do it
alone. Use about 18 inches of floss, winding most of it around the
middle fingers of both hands. Hold the floss lightly between the
thumbs and forefingers. Use a gentle, back-and-forth motion to guide
the floss between the teeth. Curve the floss into a C-shape and
slide it into the space between the gum and tooth until you feel
resistance. Gently scrape the floss against the side of the tooth.
Repeat this procedure on each tooth. Don’t forget the backs of the
last four teeth.
Good Diet = Healthy
Teeth
Healthy eating habits lead to healthy teeth. Like
the rest of the body, the teeth, bones and the soft tissues of the
mouth need a well-balanced diet. Children should eat a variety of
foods from the five major food groups. Most snacks that children eat
can lead to cavity formation. The more frequently a child snacks,
the greater the chance for tooth decay. How long food remains in the
mouth also plays a role. For example, hard candy and breath mints
stay in the mouth a long time, which cause longer acid attacks on
tooth enamel. If your child must snack, choose nutritious foods such
as vegetables, low-fat yogurt, and low-fat cheese, which are
healthier and better for children’s teeth.
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How Do I Prevent
Cavities?
Good oral
hygiene removes bacteria and the left over food particles that
combine to create cavities. For infants, use a wet gauze or clean
washcloth to wipe the plaque from teeth and gums. Avoid putting your
child to bed with a bottle filled with anything other than water.
See "Baby Bottle Tooth Decay"
for more information.
For older
children, brush their teeth at least twice a day. Also, watch
the number of snacks containing sugar that you give your children.
The American
Academy of Pediatric Dentistry recommends visits every six months to
the pediatric dentist, beginning at your child’s first birthday.
Routine visits will start your child on a lifetime of good dental
health.
Your
pediatric dentist may also recommend protective sealants or home
fluoride treatments for your child. Sealants can be applied to your
child’s molars to prevent decay on hard to clean surfaces.
Seal Out Decay
A sealant is a clear or shaded plastic material
that is applied to the chewing surfaces (grooves) of the back teeth
(premolars and molars), where four out of five cavities in children
are found. This sealant acts as a barrier to food, plaque and acid,
thus protecting the decay-prone areas of the teeth.
|
Before Sealant Applied |
After Sealant Applied |
Fluoride
Fluoride is an element, which has been shown to
be beneficial to teeth. However, too little or too much fluoride can
be detrimental to the teeth. Little or no fluoride will not
strengthen the teeth to help them resist cavities. Excessive
fluoride ingestion by preschool-aged children can lead to dental
fluorosis, which is a chalky white to even brown discoloration of
the permanent teeth. Many children often get more fluoride than
their parents realize. Being aware of a child’s potential sources of
fluoride can help parents prevent the possibility of dental
fluorosis.
Some of these sources are:
-
Too much fluoridated toothpaste at an early
age.
-
The inappropriate use of fluoride supplements.
-
Hidden sources of fluoride in the child’s diet.
Two
and three year olds may not be able to expectorate (spit out)
fluoride-containing toothpaste when brushing. As a result, these
youngsters may ingest an excessive amount of fluoride during tooth
brushing. Toothpaste ingestion during this critical period of
permanent tooth development is the greatest risk factor in the
development of fluorosis.
Excessive and inappropriate intake of fluoride
supplements may also contribute to fluorosis. Fluoride drops and
tablets, as well as fluoride fortified vitamins should not be given
to infants younger than six months of age. After that time, fluoride
supplements should only be given to children after all of the
sources of ingested fluoride have been accounted for and upon the
recommendation of your pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride,
especially powdered concentrate infant formula, soy-based infant
formula, infant dry cereals, creamed spinach, and infant chicken
products. Please read the label or contact the manufacturer. Some
beverages also contain high levels of fluoride, especially
decaffeinated teas, white grape juices, and juice drinks
manufactured in fluoridated cities.
Parents can take the following steps to decrease
the risk of fluorosis in their children’s teeth:
-
Use baby tooth cleanser on the toothbrush of
the very young child.
-
Place only a pea sized drop of children’s
toothpaste on the brush when brushing.
-
Account for all of the sources of ingested
fluoride before requesting fluoride supplements from your child’s
physician or pediatric dentist.
-
Avoid giving any fluoride-containing
supplements to infants until they are at least 6 months old.
-
Obtain fluoride level test results for your
drinking water before giving fluoride supplements to your child
(check with local water utilities).
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Mouth Guards
When a child begins to participate in
recreational activities and organized sports, injuries can occur. A
properly fitted mouth guard, or mouth protector, is an important
piece of athletic gear that can help protect your child’s smile, and
should be used during any activity that could result in a blow to
the face or mouth.
Mouth guards help prevent broken teeth, and
injuries to the lips, tongue, face or jaw. A properly fitted mouth
guard will stay in place while your child is wearing it, making it
easy for them to talk and breathe.
Ask your pediatric dentist about custom and
store-bought mouth protectors.
Xylitol - Reducing
Cavities
The American Academy of Pediatric Dentistry (AAPD) recognizes the
benefits of xylitol on the oral health of infants, children,
adolescents, and persons with special health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day) starting 3
months after delivery and until the child was 2 years old, has
proven to reduce cavities up to 70% by the time the child was 5
years old.
Studies using xylitol as either a sugar
substitute or a small dietary addition have demonstrated a dramatic
reduction in new tooth decay, along with some reversal of existing
dental caries. Xylitol provides additional protection that enhances
all existing prevention methods. This xylitol effect is long-lasting
and possibly permanent. Low decay rates persist even years after the
trials have been completed.
Xylitol is widely distributed throughout
nature in small amounts. Some of the best sources are fruits,
berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of
raspberries contains less than one gram of xylitol.
Studies suggest xylitol intake that consistently produces positive
results ranged from 4-20 grams per day, divided into 3-7 consumption
periods. Higher results did not result in greater reduction and may
lead to diminishing results. Similarly, consumption frequency of
less than 3 times per day showed no effect.
To find gum or other products containing
xylitol, try visiting your local health food store or search the
Internet to find products containing 100% xylitol.
ADOLESCENT
DENTISTRY
Tongue Piercing – Is
it Really Cool?
You might not be surprised anymore to see people
with pierced tongues, lips or cheeks, but you might be surprised to
know just how dangerous these piercings can be.
There are many risks involved with oral piercings,
including chipped or cracked teeth, blood clots, blood poisoning,
heart infections, brain abscess, nerve disorders (trigeminal
neuralgia), receding gums or scar tissue. Your mouth contains
millions of bacteria, and infection is a common complication of oral
piercing. Your tongue could swell large enough to close off your
airway!
Common symptoms after piercing include pain,
swelling, infection, an increased flow of saliva and injuries to gum
tissue. Difficult-to-control bleeding or nerve damage can result if
a blood vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental
Association and give your mouth a break – skip the mouth jewelry.
Tobacco – Bad News in Any
Form
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child about the
dangers of tobacco.
Smokeless tobacco, also called spit, chew or
snuff, is often used by teens who believe that it is a safe
alternative to smoking cigarettes. This is an unfortunate
misconception. Studies show that spit tobacco may be more addictive
than smoking cigarettes and may be more difficult to quit. Teens who
use it may be interested to know that one can of snuff per day
delivers as much nicotine as 60 cigarettes. In as little as three to
four months, smokeless tobacco use can cause periodontal disease and
produce pre-cancerous lesions called leukoplakias.
If your child is a tobacco user you should watch
for the following that could be early signs of oral cancer:
-
A sore that won’t heal.
-
White or red leathery patches on the lips, and
on or under the tongue.
-
Pain, tenderness or numbness anywhere in the
mouth or lips.
-
Difficulty chewing, swallowing, speaking or
moving the jaw or tongue; or a change in the way the teeth fit
together.
Because the early signs of oral cancer usually
are not painful, people often ignore them. If it’s not caught in the
early stages, oral cancer can require extensive, sometimes
disfiguring, surgery. Even worse, it can kill.
Help your child avoid tobacco in any form. By
doing so, they will avoid bringing cancer-causing chemicals in
direct contact with their tongue, gums and cheek.
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